OIG Uncovers Flaws in CMS Processes, Programs

A recent spate of Office of Inspector General audit reports calls into question some programs from the Centers for Medicare & Medicaid Services. It remains uncertain why the release of these audit reports have come within such a short window of time, but the fact that they are occurring should be an indication that CMS’s methods and processes are far from perfect.

The following is a look at some of the recent OIG critiques of CMS.

Audit MIC performance
An early assessment of the efforts of Audit Medicaid Integrity contractors to identify overpayments in Medicaid, generated this report. Released on March 20, it indicates that only 11% of the study-assigned audits were completed with findings of $6.9 million in overpayments, $6.2 million of which resulted from seven completed collaborative audits involving Audit MICs, Review MICs, states, and CMS.

This leaves 81% of audits in which the MICs were unable or unlikely to identify any underpayments or overpayments. The OIG deduced that problems with the data used and analyses conducted by Review MICs and CMS to identify audit targets hindered the performance of the Audit MICs.